Coatings for modifying monofilament and multi-filaments self-retaining sutures

ABSTRACT

The present invention provides that coatings applied to natural, synthetic and recombinant expressed polymer filaments can be used to modify the properties of monofilament and multifilament self-retaining sutures. In an embodiment of the invention, the coating enables the suture to be easily inserted into tissue, whereupon the extended interaction of the coating and the tissue increase the ability of the tissue retainers to hold the suture in the tissue. In an embodiment of the present invention, the coated polymers have a melting point in the range from between approximately 40° C. to approximately 180° C. while retaining tensile strength. In an embodiment of the invention, the increased strength is due in part to the tissue specific reaction generated by the suture coating.

FIELD OF THE INVENTION

The present invention relates to self-retaining (“barbed”) systems forsurgical and cosmetic procedures, methods of manufacturingself-retaining systems for surgical and cosmetic procedures, includingcombining synthetic, natural and recombinant polymer materials, coatingsfor modifying the suture properties and methods of testingself-retaining sutures. Coatings are used to modify monofilament andmultifilament self retaining suture properties.

BACKGROUND OF THE INVENTION

Sutures are stitches that surgeons use to hold skin, internal organs,blood vessels and other tissues of the human body together, after suchtissues have been severed by injury or surgery. Depending on theapplication, sutures must be flexible, sufficiently strong to not break,non-toxic and non-hypoallergenic, in order to avoid adverse reactions inthe patient's body. The flexibility of the suture is important insituations where the sutures must be drawn and knotted easily. Inaddition, the suture must lack the so called “wick effect”, which meansthat sutures must not allow fluids to penetrate the body or organ fromthe outside.

Suture materials can be broadly classified as being bioabsorbable andnon-bioabsorbable materials. Bioabsorbable sutures will break downharmlessly in the body over time without intervention. Non-bioabsorbablesutures must either be left indefinitely in place or manually removed.The type of suture used varies depending on the operation, with a majorcriteria being the demands of the location of the wound or incision andthe local environment. For example, sutures to be placed internallywould require re-opening of the patient's body if the suture were to beremoved. Alternatively, sutures which address a wound or incision on theexterior of the patient's body can be removed within minutes, andwithout re-opening the wound. As a result, bioabsorbable sutures areoften used internally and non-bioabsorbable sutures externally. Further,sutures to be placed in a stressful environment, for example near theheart where there is constant pressure and movement or near or on thebladder, may require specialized or stronger materials to perform thedesired role. Usually such sutures can be either specially treated, ormade of special materials, and are often non-bioabsorbable to reduce therisk of degradation

Suture sizes are defined by the United States Pharmacopeia (U.S.P.) theofficial public standards-setting authority for all prescription andover-the-counter medicines, dietary supplements, and other healthcareproducts manufactured and sold in the United States. Sutures can bemanufactured ranging in decreasing sizes from #6 to #11/0, where #5corresponds with a heavy braided suture for orthopedics, while #10/0 isa fine monofilament suture for ophthalmic applications. The actualdiameter of thread for a given U.S.P. size differs depending on thesuture material class.

A suture containing ‘tissue retainers’ or ‘barbs’ can be useful as awound closure device. Such self-retaining (barbed) suture systems havepreviously been developed for a variety of surgical procedures. Theself-retaining suture includes an elongated body and a plurality oftissue retainers projecting from the body. As described in greaterdetail below, tissue retainers may take a number of differentconfigurations, including, among other configurations, barbs. Eachtissue retainer helps the suture resist movement in a direction oppositefrom which the tissue retainer faces. The disposition of the tissueretainers on the suture body can be ordered, e.g., staggered, spiral,overlapping, or random. Also, the tissue retainers can be configuredwith a specific angle, depth, length and separation distance.

SUMMARY OF THE INVENTION

In an embodiment of the invention, self-retaining sutures can be madefrom biomaterials with coatings applied. In various embodiments of theinvention, the coatings can include natural wax, synthetic wax, lowviscosity glycolic acid polymers, lactic acid polymers, trimethylenecarbonate polymers, paradioxanone polymers, epsilon-caprolactonepolymers, polyhydroxyalkanoates, urethane, collagen, and silicones. Inan embodiment of the invention, the coating facilitates the easyinsertion of the suture into the tissue. In an embodiment of theinvention, the extended interaction of the coating and the tissueresults in an increase in the resistance of the tissue retainer in thetissue. In various alternative embodiments of the invention, the sutureincludes filaments which can be made from non-biodegradable materialsincluding collagen, polypropylene, polyester, nylon, polyamide,polybutesters, polyetherester, polyetheretherketone, polyethylene,polyethylene terephthalate, polyurethane, polypropylene,polytetrafluoroethylene, metals, metal alloys, cotton and silk. Invarious embodiments of the invention, the non-biodegradable material iscoated with biodegradable materials including polyglycolic acid,poly-l-lactic acid, poly-d-lactic acid, polytrimethylene carbonate,polydioxanone, polycaprolactone, polyurethane, protamine, polylysine,lipids, and recombinant polyhydroxyalkanoate (rPHA) polymers. In variousembodiments of the invention, the biodegradable material when insertedin vivo causes a tissue response reaction. The tissue response reactionincreases the deposition of collagen around the site of the tissueretainer, thereby increasing the tissue retainer resistance to pull outfrom the tissue.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a perspective view of an embodiment of a coated self-retainingsuture of the present invention.

FIG. 2 is a perspective view of an embodiment of a coated bidirectionalself-retaining suture of the present invention.

FIG. 3 is a perspective view of an embodiment of a multifilament coatedsuture of the present invention.

FIG. 4 is a perspective view of an embodiment of a multifilamentbidirectional self-retaining suture of the present invention.

DETAILED DESCRIPTION OF THE INVENTION

Bioabsorbable sutures can be made of materials which are broken down intissue after a given period of time, which depending on the material canbe from ten days to eight weeks. The sutures are used therefore in manyof the internal tissues of the body. In most cases, three weeks issufficient for the wound to close firmly. At that time the suture is notneeded any more, and the fact that it disappears is an advantage, asthere is no foreign material left inside the body and no need for thepatient to have the sutures removed. In rare cases, bioabsorbablesutures can cause inflammation and be rejected by the body rather thanabsorbed. Bioabsorbable sutures were first made from the intestines ofmammals. For example, gut sutures can be made of specially preparedbovine or ovine intestine, and may be untreated (plain gut), tanned withchromium salts to increase the suture persistence in the body (chromicgut), or heat-treated to give more rapid absorption (fast gut). Concernabout transmitting diseases such as bovine spongiform encephalopathy,has resulted in the gut being harvested from stock which have beentested to determine that the natural polymers used as suture materialsdo not carry viral diseases. Bioabsorbable sutures can be made ofsynthetic polymer fibers, which may be monofilaments or braided.

Synthetic sutures offer numerous advantages over gut sutures, notablyease of handling, low cost, low tissue reaction, consistent performanceand non-toxicity. Various blends of polyglycolic acid, lactic acid orcaprolactone are common as synthetic bio-absorbable sutures. Examples ofbioabsorbable sutures include sutures made from catgut (collagen),kangaroo tendons, glycolic acid polymers, l-lactic acid polymers,d-lactic acid polymers, trimethylene carbonate polymers, para-dioxanonepolymers, epsilon-caprolactone polymers, polyhydroxyalkanoate polymersas well as copolymers using any combination of these materials as wellas other chemically similar materials.

Non-bioabsorbable sutures can be made of materials which are notmetabolized by the body, and are used therefore either on skin woundclosure, where the sutures can be removed after a few weeks, or in someinner tissues in which absorbable sutures are not adequate. This is thecase, for example, in the heart and in blood vessels, whose rhythmicmovement requires a suture which stays longer than three weeks, to givethe wound enough time to close. Other organs, like the bladder, containfluids which make absorbable sutures disappear in only a few days, tooearly for the wound to heal. There are several materials used fornon-bioabsorbable sutures. The most common is a natural fiber, silk.Other non-bioabsorbable sutures can be made of artificial fibers, likepolypropylene, polyester or nylon; these may or may not have coatings toenhance the suture performance characteristics. Likewise, examples ofnon-bioabsorbable sutures include sutures made from polyamide,polybutesters, polyetherester, polyetheretherketone, polyethylene,polyethylene terephthalate, polyurethane, polypropylene,polytetrafluoroethylene, metals, metal alloys, cotton and silk.

It is important to understand that the classification of bioabsorbableand non-bioabsorbable sutures is not absolute. For example, mostpolyesters are non-bioabsorbable (such as polyethylene terephthalate)except that some polyesters (such as those made from polyglycolic acid,polylactic acid, or polyhydroxyalkanoates) are bioabsorbable. Similarly,silk is generally considered as a non-bioabsorbable material, but over along period of time (e.g., 10 to 25 years), the body can break-down silksutures implanted in the body.

Polyhydroxyalkanoic acids (PHAs) are carbon and energy reserve polymersproduced in some bacteria when carbon sources are plentiful and othernutrients, such as nitrogen, phosphate, oxygen, or sulfur are limiting.Naturally occurring PHAs are composed of monomers that range from 3 to14 carbons. PHAs can be made by genetically engineering microorganismsincluding Ralstonia eutropha (R. eutropha) (formerly Alcaligeneseutrophus) or Escherichia coli (E. coli) bacteria to biologicallysynthesize the desired PHAs. Bioabsorbable linear polyesters such as PHAmade from bacteria can be produced through fermentation using sugars andor lipids as the carbon and energy sources. Some PHA polyesters havephysical properties similar to those of polypropylene, making them analternative source of plastic which is biodegradable and can be formedfrom renewable resources. Homopolymers composed of 3-hydroxybutyric acid(PHB) are very brittle. In contrast PHAs possessing longer carbonbackbones including poly-3-hydroxyhexanoate (PHH) andpoly-3-hydroxyoctanoate (PHO) result in a more flexible polymer. As aresult, homopolymers of PHH and PHO are more attractive for use inmaking sutures.

PHB was first discovered in 1927 at the Pasteur Institute in Paris. In anatural state, PHB exists as a noncrystalline polymer, but theextraction procedures convert it to be high crystalline and brittle,which limited its application. PHB can be chemically synthesized bycatalytic ring-opening polymerization of 3-butyrolactone, but isindustrially biosynthesized from renewable resources by bacteria actionon sugar of wheat or beet.

PHB is synthesized from acetyl-coenzyme A (CoA) in a three-step pathway.The first reaction involves a PHA-specific 3-ketothiolase, encoded byphaARe, that condenses two acetyl-CoA molecules into acetoacetyl-CoA.The second reaction, which is the reduction of acetoacetyl-CoA tod-(−)-3-hydroxybutyryl-CoA, is catalyzed by an NADPH-dependentacetoacetyl-CoA reductase, encoded by phaBRe. The last reaction iscatalyzed by PHA synthase, which is the product of the phaCRe gene. Inthis reaction, d-(−)-3-hydroxybutyrl-CoA is linked to an existing PHAmolecule by the formation of an ester bond. In addition to thethree-step pathway just described, different (d)-3-hydroxyacyl-CoAsubstrates may be used by the PHA synthase to construct PHAs ofdifferent monomeric compositions. These alternative substrates for PHAsynthase could be provided by intermediates of other metabolic pathways,such as the fatty acid oxidation pathway, the fatty acid synthesispathway, the methylmalonyl-CoA pathway, and the isoleucine-valinedegradation pathway.

Chromobacterium violaceum (C. violaceum) is known to accumulate polymerscomposed primarily of PHB and PHBV and can produce a homopolymer of 3HVwhen grown on valerate (see Kolibachuk, D. et al., Appl. EnvironMicrobiol. (1999) 65, pp 3561-3565, entitled “Cloning, MolecularAnalysis, and Expression of the Polyhydroxyalkanoic Acid Synthase (phaC)Gene from Chromobacterium violaceum” which is expressly incorporated byreference in its entirety). R. eutropha harboring a 6.3-kb BamHIfragment from C. violaceum, containing phaCCv and thepolyhydroxyalkanoic acid (PHA)-specific 3-ketothiolase (phaACv) producedsignificant levels of PHA synthase and 3-ketothiolase. C. violaceumaccumulated recombinant PHB (rPHB) or recombinant PHBV (rPHBV) whengrown on a fatty acid carbon source. In contrast, R. eutropha, harboringthe phaCCv fragment, accumulated rPHB, rPHBV and the rPHBH wheneven-chain-length fatty acids were utilized as the carbon source. TheKolibachuk report verifies the ability of the synthase from C. violaceumto incorporate other rPHA monomers to form a variety of copolymers.

PHBV copolymers have molecular weights of about 500,000 g/mol and are100% isotactic. The stereoregularity is superior to that of thechemically synthesized polymers of comparable molecular weights byring-opening copolymerization of lactones. The flexibility and tensilestrength of the copolymer depend on the HV content. The PHBV copolymersshow piezo-electric properties, are stable in water and alcohol and areweakly resistant to acids and alkalis. The PHBV copolymer degradesfaster than PHB. The mechanical properties of different compositionPHBV's are given in Table 1.

TABLE 1 Properties of PHBV copolymers. HB:HV content 100% HB 92% HB, 8%HV 88% HB, 12% HV Tg/° C. 1 −1 2 Tm/° C. 179 153 144 TS (MPa) 40 28 23 %Elongation 6-8 20 352 Modulus (GPa) 3.5 2 1.4 Crystallinity 60-80 5

Thus, the compositions of the polymers produced from bacteria can bevaried depending on the substrate specificity of the PHA synthase, thecarbon source on which the bacterium is grown, and the metabolicpathways involved in the utilization of the carbon source. During the1980s, ICI/Zeneca researchers reported transferring three genesresponsible for PHB production in R. eutropha to E. coli resulting inthe recombinant bacterial synthesis of PHB. In 1996 Monsanto beganmarketing a copolymer composed of poly(3-hydroxybutyrate-co-3-hydroxyvalerate) (PHBV) under the trademark nameBIO-POL®. In 1992 a team at the Department of Energy Plant research labat Michigan State University took two genes from PHB-making bacteria andinserted them directly into Arabidopsis thaliana (cruciferae, ‘Thalecress’) and the plants accumulated PHB up to 14% by dry weight asgranules within the plastids, with no deleterious effect on growth. Themaximum thickness of rPHBV is 1 mm which would allow a variety ofdifferent size sutures up to and including orthopedic sutures.

Careful control of the starting materials and the choice of productionorganisms enables the production of an entire PHA family with differentproperties, such as the copolyester with random combinations ofβ-hydroxybutyrate and β-valerate. Such copolyesters have much bettermechanical properties (that are similar to those of Polypropylene) thanthose of the homopolymers. Some examples of PHAs with longer alkylgroups produced by bacteria in the form of copolymers, useful asthermoplastic elastomers, include poly((3-hydroxybutyrate-co-3-hydroxypropionat)(PHBP), poly(3-hydroxybutyrate-co-3-hydroxyhexnoate) (PHBH), and poly(3-hydroxybutyrate-co-4-hydroxybutyrate) (PHBB). A number of PHB-basedplastics have been developed for packaging application (U.S. Pat. Nos.5,231,148 and 5,625,029 which are expressly incorporated by reference intheir entireties). The mechanical properties of some of these copolymersare listed in Table 2.

TABLE 2 Properties of PHB copolymers Copolymers PHB/PCL PHB/PBA PHBVPHB/PEO Composition 77/23 75/25 74/26 75/25 Tg/° C.  1/—  −4/−68 8 −21Tm/° C. 178/59  175/55  178 178/61  TS (MPa) break 21 32 % Elongation 97 0 0 Modulus (MPa) 730 1050

The exciting potential of production of biodegradable plastics usingabundant renewable resources (corn, soybean, etc.) is apparent from thespate of recent joint-ventures as well as business purchases by bigmultinational commodity firms, like Monsanto and Cargill. Monsantoengineered cress plants and oil-seed rape, manipulating the plant'sproduction of amino acids and fatty acid in order to produce the plasticPHBV. Cargill Dow Polymers recently developed lactic acid productiontechnology based on corn starch that will enable low cost production ofPLA. Among others, both BASF and Eastman Chemical have developedbiodegradable aliphatic/aromatic co-polyester that may be produced inexisting polyester facilities. Some industrial resins are summarized inTable 3.

TABLE 3 Commercial Industrial Resins. Category Polymer Trade NameBiosynthetic PHBV Biopol (Monsanto) Poly (lactide) EcoPla Nature Work(Cargill Dow) Lacea (Mitsui Chemicals) Pullulan Pullulan (Hayashihara)Chemo Poly (butylene succinate) Bionolle 1000 (Showa syntheticHighpolymer) Poly (butylene succinate adipate) Bionolle 3000 (ShowaHighpolymer) Poly (butylene succinate Biomax (DuPont) terephthalate)Copolyester Ecoflex (BASF) Copolyester Eastar Bio (Eastman Chemicals)Polycaprolactone Tone (Union Carbide) Poly (vinyl alcohol) Airvol (AirProducts and Chemicals) Poly (ester amide) BAK (Bayer) Natural Celluloseacetate EnviroPlastic-Z (Planet Polymer) Starch-based polycaprolactoneBioplast (Biotec) Starch-based plastic Mater-Bi (Novamont)

A basic requirement of medical devices is that the devices arenonpyrogenic, i.e., that the products do not induce fever reactions whenadministered to patients. The presence of bacterial endotoxin in abacterially expressed rPHA is by far the largest concern ofmanufacturers in achieving nonpyrogenation. The U.S. Food and DrugAdministration (FDA) requires the endotoxin content of medical devicesnot exceed 20 USP endotoxin units (EU) per device. Endotoxin levels needto be even lower for some specific applications. While this isparticularly relevant for rPHAs derived by fermentation of gram-negativebacteria there are also concerns for rPHAs derived from plants.Therefore, in developing rPHAs for use as self-retaining sutures, therPHAs specific endotoxin content requirements can be analyzed todetermine whether the sutures exceed the FDA limits.

‘Self-retaining suture’ refers to a suture that may not require a knotin order to maintain its position into which it is deployed during asurgical procedure. Such self-retaining sutures generally include aretaining element or tissue retainer.

‘Tissue retainer’ refers to a suture element having a retainer bodyprojecting from the suture body and a retainer end adapted to penetratetissue. Each retainer is adapted to resist movement of the suture in adirection other than the direction in which the suture is deployed intothe tissue by the surgeon, by being oriented to substantially face thedeployment direction (i.e. the retainers lie flat when pulled in thedeployment direction; and open or “fan out” when pulled in a directioncontrary to the deployment direction). As the tissue-penetrating end ofeach retainer faces away from the deployment direction when movingthrough tissue during deployment, the tissue retainers should generallyavoid catching or grabbing tissue during this phase. Once theself-retaining suture has been deployed, a force exerted in anotherdirection (often substantially opposite to the deployment direction)causes the retainers to be displaced from their deployment positions(i.e. resting substantially along the suture body), forces the retainerends to open (or “fan out”) from the suture body in a manner thatcatches and penetrates into the surrounding tissue, and results intissue being caught between the retainer and the suture body; thereby“anchoring” or affixing the self-retaining suture in place. By way ofexample only, tissue retainer or retainers can include hooks,projections, barbs, darts, extensions, bulges, anchors, protuberances,spurs, bumps, points, cogs, tissue engagers, tractions means, surfaceroughness, surface irregularities, surface defects, edges, facets andthe like. FIG. 1 provides an example of an embodiment of the presentinvention, a coated self-retaining suture 100 with tissue retainers 102on suture filament 104. Self-retaining sutures may be unidirectional,meaning that all tissue retainers on the suture are oriented in onedirection, or they may be bidirectional, meaning that a first group ofat least one tissue retainer on a first portion of the suture isoriented in one direction while a second group of at least one suture ona second portion of the suture is oriented in another direction. FIG. 2illustrates an example of another embodiment of the present invention, acoated bidirectional self-retaining suture 200 having a plurality oftissue retainers 202 arranged to point in one direction and a secondplurality of tissue retainers 204 arranged to point in a directiondifferent from (and generally opposite to) the direction of retainers202. Additionally, the sutures of the present invention may bemonofilamentary or multifilamentary. A multifilamentary example of anembodiment of the present invention is illustrated in FIG. 3, in whichcoated suture 300 has filaments 302 and 304. In some multifilamentaryembodiments, at least one filament may have tissue retainers. An exampleof such an embodiment is shown in FIG. 4, where coated suture 400 ismade up of filaments 402 and 404, wherein filament 404 has retainers406.

Various forms of rPHBV are characterized by melting points of betweenapproximately 130° C. to approximately 180° C., and extensions-to-breakstrengths of 8 to 42% (see Zeneca Promotional Literature, Billingham, UK1993; and U.S. Patent Application No.: 20020106764 to A. Steinbuchel, etal. entitled “Sulfur containing polyhydroxyalkanoate compositions andmethod of production”, which are hereby expressly incorporated byreference in their entireties. Forms of rPHBV are also some of thestrongest bioabsorbable fibers known, offering up to 50% greater tensilestrength than glycolic acid polymer monofilament bioabsorbable sutures.As a result, rPHBV is both tougher than and more flexible than PHB.Further, rPHBV has an absorption rate and degradation profile that iscompatible with human tissue repair and replacement applications.However, unlike other biopolymers such as collagen and hyaluronate, PHBVis a thermoplastic. As such rPHBV can be fabricated into virtually anyshape or form including fibers, films, tubes, foams, textiles,microspheres, and molded constructs, using a wide range of conventionalmelt and solvent processing techniques. Another PHA with attractivephysical properties is a copolymer of 3-hydroxybutyrate-and-3-hydroxyhexanoate (rPHBH).

In an embodiment of the invention, sutures can be made from biomaterialssuch as recombinant polyhydroxyalkanoate (rPHA) polymers synthesized inbacterial expression systems. In an embodiment of the invention, ahomopolymer material synthesized by a recombinant bacterial expressionsystem can be used as a material for making a self-retaining suture. Inan embodiment of the present invention, rPHA homopolymers can be used asa monofilament for making a self-retaining suture. In an embodiment ofthe present invention, rPHA homopolymers can be used to formmulti-filaments for making a self-retaining suture. In variousembodiments of the invention, rPHA homo polymers includingpoly-3-hydroxybutyrate (PHB), poly-4-hydroxybutyrate (P4HB),poly-3-hydroxyvalerate (PHV), poly-3-hydroxypropionate (PHP),poly-2-hydroxybutyrate (P2HB), poly-4-hydroxyvalerate (P4HV),poly-5-hydroxyvalerate (P5HV), poly-3-hydroxyhexanoate (PHH),poly-3-hydroxyoctanoate (PHO), poly-3-hydroxyphenylvaleric acid (PHPV)and poly-3-hydroxyphenylhexanoic acid (PHPH) can be used as materialsfor making self-retaining sutures. In an embodiment of the presentinvention, rPHA homopolymers having melting points (Tm) ranging betweenapproximately 40° C. to approximately 180° C. can be used as materialsfor making self-retaining sutures.

In an alternative embodiment of the invention, a rPHA block or randomcopolymer material synthesized in a bacterial expression system can beused for making a self-retaining suture. In an embodiment of the presentinvention, rPHA copolymers can be used as a monofilament for making aself-retaining suture. In an alternative embodiment of the presentinvention, rPHA block and/or random copolymers can be used to formmulti-filaments for making a self-retaining suture. Roughly 100different types of rPHAs have been produced by fermentation methods. Anumber of these rPHAs contain functionalized pendant groups such asesters, double bonds, alkoxy, aromatic, halogens, and hydroxyl groupswhich can be further crosslinked, reacted, derivatized or undergo noncovalent interactions to modify the properties of the rPHA. In additionto transgenic systems for producing rPHAs in both microorganism andplants, enzymatic methods for PHA synthesis are known (see Steinbucheland Valentin, FEMS Microbiol. Lett., 128:219 28 (1995) and Williams andPeoples, CHEMTECH, 26:38 44 (1996), which are both hereby expresslyincorporated by reference in their entireties). In various embodimentsof the invention, rPHA copolymers including poly(3-hydroxybutyrate-co-3-hydroxyvalerate) (PHBV), poly(3-hydroxybutyrate-co-3-hydroxyhexanoate) (PHBH), poly(3-hydroxybutyrate-co-4-hydroxyhexanoate) (PHB4H), poly(3-hydroxybutyrate-co-6-hydroxyhexanoate) (PHB6H), poly(3-hydroxybutyrate-co-3-hydroxyoctanoate) (PHBO), poly(3-hydroxybutyrate-co-3-hydroxyphenylvaleric acid) (PHBPV), poly(3-hydroxybutyrate-co-3-hydroxyphenylhexanoic acid) (PHBPH), poly(4-hydroxybutyrate-co-3-hydroxyvalerate) (P4HBV), poly(4-hydroxybutyrate-co-3-hydroxyhexanoate) (P4HBH), poly(4-hydroxybutyrate-co-4-hydroxyhexanoate) (P4HB4H), poly(4-hydroxybutyrate-co-6-hydroxyhexanoate) (P4HB6H), poly(4-hydroxybutyrate-co-3-hydroxyoctanoate) (P4HBO), poly(4-hydroxybutyrate-co-3-hydroxyphenylvaleric acid) (P4HBPV), poly(4-hydroxybutyrate-co-3-hydroxyphenylhexanoic acid) (P4HBPH), poly(3-hydroxyvalerate-co-3-hydroxyhexanoate) (PHVH), poly(3-hydroxyvalerate-co-4-hydroxyhexanoate) (PHV4H), poly(3-hydroxyvalerate-co-6-hydroxyhexanoate) (PHV6H), poly(3-hydroxyvalerate-co-3-hydroxyoctanoate) (PHVO), poly(3-hydroxyvalerate-co-3-hydroxyphenylvaleric acid) (PHVPV), poly(3-hydroxyvalerate-co-3-hydroxyphenylhexanoic acid) (PHVPH), poly(3-hydroxyvalerate-co-3-hydroxyphenylvaleric acid) (PHVPV), poly(3-hydroxyvalerate-co-3-hydroxyphenylhexanoic acid) (PHVPH), poly(3-hydroxypropionate-co-3-hydroxyvalerate) (PHPV), poly(3-hydroxypropionate-co-3-hydroxyhexanoate) (PHPH), poly(3-hydroxypropionate-co-4-hydroxyhexanoate) (PHP4H), poly(3-hydroxypropionte-co-6-hydroxyhexanoate) (PHP6H), poly(3-hydroxypropionate-co-3-hydroxyoctanoate) (PHPO), poly(3-hydroxypropionate-co-3-hydroxyphenylvaleric acid) (PHPPV), poly(3-hydroxypropionate-co-3-hydroxyphenylhexanoic acid) (PHPPH), poly(2-hydroxybutyrate-co-3-hydroxyvalerate) (P2HBV), poly(2-hydroxybutyrate-co-3-hydroxyhexanoate) (P2HBH), poly(2-hydroxybutyrate-co-4-hydroxyhexanoate) (P2HB4H), poly(2-hydroxybutyrate-co-6-hydroxyhexanoate) (P2HB6H), poly(2-hydroxybutyrate-co-3-hydroxyoctanoate) (P2HBO), poly(2-hydroxybutyrate-co-3-hydroxyphenylvaleric acid) (P2HBPV), poly(2-hydroxybutyrate-co-3-hydroxyphenylhexanoic acid) (P2HBPH), poly(4-hydroxyvalerate-co-3-hydroxyvalerate) (P4HVV), poly(4-hydroxyvalerate-co-3-hydroxyhexanoate) (P4HVH), poly(4-hydroxyvalerate-co-4-hydroxyhexanoate) (P4HV4H), poly(4-hydroxyvalerate-co-6-hydroxyhexanoate) (P4HV6H), poly(4-hydroxyvalerate-co-3-hydroxyoctanoate) (P4HVO), poly(4-hydroxyvalerate-co-3-hydroxyphenylvaleric acid) (P4HVPV), poly(4-hydroxyvalerate-co-3-hydroxyphenylhexanoic acid) (P4HVPH), poly(5-hydroxyvalerate-co-3-hydroxyvalerate) (P5HVV), poly(5-hydroxyvalerate-co-3-hydroxyhexanoate) (P4HVH), poly(5-hydroxyvalerate-co-4-hydroxyhexanoate) (P5HV4H), poly(5-hydroxyvalerate-co-6-hydroxyhexanoate) (P5HV6H), poly(5-hydroxyvalerate-co-3-hydroxyoctanoate) (P5HVO), poly(5-hydroxyvalerate-co-3-hydroxyphenylvaleric acid) (P5HVPV), poly(5-hydroxyvalerate-co-3-hydroxyphenylhexanoic acid) (P5HVPH), can beused as materials for making self-retaining sutures. In an embodiment ofthe present invention, rPHA copolymers have melting points rangingbetween approximately 40° C. to approximately 180° C.

In a further alternative embodiment, a rPHA homo polymer is used as themonofilament base material for making a self-retaining suture. In anembodiment of the present invention, a monofilament can be coated with arPHA copolymer, for use as a self-retaining suture. In an embodiment ofthe invention, self-retaining sutures can be made from rPHBV copolymers.In an alternative embodiment of the invention, self-retaining suturescan be made from rPHBH copolymers. In an embodiment of the presentinvention, rPHA copolymers have varied elastomeric and/or thermoplasticproperties compared with the corresponding PHA synthetic copolymer. Inan embodiment of the present invention, rPHA copolymers from R. eutrophahave varied elastomeric and/or thermoplastic properties compared withthe corresponding synthetic polymer. In an embodiment of the invention,a self-retaining suture material made from a monofilament ormultifilament coated with a rPHA homopolymer can have a melting pointranging between approximately 40° C. to approximately 180° C. In anembodiment of the invention, a self-retaining suture material made froma monofilament or multifilament coated with a rPHA block or randomcopolymer can have a melting point ranging between approximately 40° C.to approximately 180° C.

In an embodiment of the present invention, rPHA homopolymers are blendedwith rPHA block and/or random copolymers to produce material for makingself-retaining sutures. In an alternative embodiment of the presentinvention, rPHA homopolymers are cross-linked with rPHA block and/orrandom copolymers to produce material for making self-retaining sutures.In another embodiment of the present invention, rPHA homopolymers arechemically reacted with rPHA block and/or random copolymers to producematerial for making self-retaining sutures.

Polyglycolic acid (PGA) is the simplest aliphatic polyester polymer. Themonomer, glycolic acid, occurs naturally in sugarcane syrup and in theleaves of certain plants, but can also be synthesized chemically.Ring-opening polymerization of the cyclic dimmer, glycolide, yields highmolecular weight polymers. PGA has a high crystallinity (45-55%) thatleads to its insolubility in water and most organic solvents. Glycolicacid has been copolymerized with other monomers to reduce thecrystallinity and stiffness of the resulting copolymers. Thesecopolymers, such as poly (glycolide-co-1,3-trimethylene carbonate)(TMC/PGA) trade name polyglyconate) (U.S. Pat. No. 5,695,879 which isexpressly incorporated by reference in its entirety), poly(lactide-co-glycolide) (PLAGA) (U.S. Pat. No. 4,960,866 which isexpressly incorporated by reference in its entirety), poly(glycolide-co-ethylene oxide) (PGA/PEO) and poly(glycolide-co-p-dioxanone) (PGA/PDO), are used in medical devices ordrug delivery systems. PGA undergoes enzymatic and hydrolyticdegradation.

Poly-lactic acid (PLA) is the most widely used biodegradable polyester.PLA polymers are not only used as implants in human bodies, but can alsoreplace petroleum-based polymers in many application items. The monomerlactic acid is found in blood and muscle tissue as a product of themetabolic process of glucose. High molecular weight polylactide isobtained by ring-opening polymerization of the cyclic dimer of lacticacid. Lactic acid can be derived by fermentation of starchy productssuch as corn, and then converted to PLA through low-cost, high-yieldcatalytic polymerization (U.S. Pat. No. 5,981,694 which is expresslyincorporated by reference in its entirety). Due to the asymmetrical βcarbon of lactide acid, D and L stereoisomers exist, and the resultingpolymer can be either isomeric (D, L) or racemic DL. Petrochemical PLAis a mixture of D- and L-stereoisomer (50/50), whereas the fermentationof renewable resources forms uniquely L-lactic acid. Proteinase Kpreferentially degrades L-L, L-D and D-L bonds as opposed to D-Dlinkages. PLA is water resistant, unstable in acidic and alkalisolutions, soluble in halogenated hydrocarbons, ethyl acetate, THF anddioxane. Poly (L-lactic acid) (PLLA) is semi-crystalline, and suitablefor applications such as orthopedic fixings and sutures (U.S. Pat. No.5,567,431 which is expressly incorporated by reference in its entirety).Poly (D,L-lactic acid) (PDLLA) is amorphous, degrades more rapidly, andis more attractive as a drug delivery system. PLA degrades viacomposting within three weeks, by first undergoing a hydrolysis reactionand then a microbial decomposition during which carbon dioxide and waterare generated. PLA is more hydrophobic than PGA and hydrolyzed moreslowly in vivo.

Polycaprolactone (PCL) is a water stable, hydrophobic andsemi-crystalline polymer. The preparation of PCL and its copolymers fromε-caprolactone can be effected by different mechanisms includinganionic, cationic, coordination and radical polymerization. PCL can behydrolyzed by fungi or through chemical hydrolysis. Chemical degradationof PCL is slower than poly (α-hydroxyalkanoic acids). Since thedegradation of PCL needs about 2 years, copolymers have been developedfor applications demanding an accelerated degradation rate. PCLpossesses good mechanical properties, is more hydrophobic than andcompatible with many polymers. Properties of some industrial PCLproducts can be found in Table 4. PCL as a thermoplastic finds manyapplications in packaging, adhesives, controlled release of drugs,fertilizers, pesticides, polymer processing, medical devices (see U.S.Pat. No.: 5,753,781 to J.D. Oxman et al. entitled “Blendedpolycaprolactone thermoplastic molding composition”), and syntheticwound dressings.

TABLE 4 Comparison of Properties of PCL products. Trade name CAPA 650CAPA 680 Tone p767 Tone p787 Solvay Solvay Union Union Producer InteroxInterox Carbide Carbide Tg/° C. −60 −60 −60 −60 Tm/° C. 60-62 60-62 6060 TS (MPa) 21-26 39-42 % Elongation >700 920 600-1000 750-1000 Yieldstress (GPa) 17.2-17.5 14-16 Fracture stress 29+/−11 54 Crystallinity 5656

Poly (p-dioxanone) (PDO), also referred as poly (oxyethylene glycoate)and poly (ether ester) is formed by the ring-opening polymerization ofp-dioxanone (U.S. Pat. No. 4,490,326). The polymer must be processed atthe lowest possible temperature to prevent depolymerization back tomonomer. The monofilament loses 50% of its initial breaking strengthafter 3 weeks and is absorbed within 6 months, providing an advantageover other products as a suture for slow-healing wounds.

In an embodiment of the present invention, one or more rPHAs are coatedor otherwise blended with one or more non-recombinant bioabsorbablepolymers to produce material for making self-retaining sutures, wherethe other bioadsorbable polymers include PGA, PLLA, poly-d-lactic acid,polytrimethylene carbonate, PDO and PCL. By coating the suture firstpolymer filament with a second polymer, a tissue specific reaction canbe induced by the exterior coating. In an embodiment of the presentinvention, one or more rPHAs are chemically cross-linked with one ormore other bioabsorbable polymers to produce material for makingself-retaining sutures, where the other bioadsorbable polymers includepolyglycolic acid, poly-l-lactic acid, poly-d-lactic acid,polytrimethylene carbonate, PDO, PCL, polyurethane, protamine,polylysine and lipids. In an embodiment of the invention, the filamentmaterial is able to induce a tissue specific reaction and the coating isnot able to induce a tissue specific reaction. By placing the coating ofthe filament and then inserting tissue retainers, the tissue specificreaction is localized on the suture tissue retainers which therebydirects the collagen deposition on or surrounding the tissue retainersto strengthen the tissue retainers insertion into the tissue. In anembodiment of the present invention, collagen fibers are coated onto abioabsorbable self-retaining monofilament to increase the tissuereaction and improve the post operative self-retaining holding strength.In an alternative embodiment of the present invention, a bioabsorbabletissue retainer suture coating further comprises small collagen fibersblended into a bioadsorbable self-retaining monofilament to increase thetissue reaction and improve the post operative self-retaining holdingstrength. In an embodiment of the present invention, small PGA fibers,regular shaped PGA spheres and irregular shaped PGA spheres areincorporated into a bioabsorbable self-retaining monofilament polymer toincrease the tissue reaction and improve the post operativeself-retaining holding strength. In various embodiments of the presentinvention, a bioabsorbable self-retaining suture coating furtherincludes one or more of small PGA fibers, regular shaped PGA spheres andirregular shaped PGA spheres into a bioabsorbable monofilament polymerwith tissue retainers to increase the tissue reaction and improve thepost operative self-retaining holding strength.

PHAs can be treated with a chemical reagent to cleave ester linkages inthe polymer backbone resulting in the formation of free hydroxyl andcarboxylic acid groups, thereby altering the local structure, the localand overall charge and providing reactive functional groups forsubsequent modification and/or coordination. This chemical treatment canalso promote or reduce cellular adhesion by the polymer. Reagents whichcan be used to cleave the polymer backbone include water, bases, acids,nucleophiles, electrophiles, plasma, and metal ions. Hydrolysis of theesters can also be performed enzymatically using esterases or,alternatively, bonds can be cleaved by ultra violet or infraredirradiation and/or the application of heat. These modifications can becarried out homogeneously if the PHA is in solution. Alternatively, ifthe PHA is an extruded solid, then the modifications can be limited tothe exposed polymer surface area. This allows surface properties of thePHAs to be modified without altering the overall mechanical propertiesof the underlying polymer. Certain PHAs with exposed unsaturated groupscan be oxidized to diols, alcohols, aldehydes, and acids. Bioactivespecies can also be covalently attached to the exposed functional groupsof PHAs. In an embodiment of the present invention, one or more rPHAsare chemically reacted with one or more non-recombinant bioabsorbablepolymers to produce material for making self-retaining sutures, wherethe non-recombinant bioadsorbable polymers include polyglycolic acid,poly-l-lactic acid, poly-d-lactic acid, polytrimethylene carbonate, PDO,PCL, protamine, polylysine and lipids.

Bioactive species can also be ionically attached to the exposedfunctional groups of PHAs. For example, the PHAs which include acarboxylic acid group can form an ionic bond with amine groups presenton materials such as protamine and polylysine or a hydrogen bond withcollagen or polyurethane or with other materials. Such modificationscan, for example, change surface properties like hydrophobicity andsurface charge of the polymers. Other examples of molecules which canmodify PHAs non-covalently are lipids. In an embodiment of the presentinvention, one or more rPHAs are non covalently modified with one ormore native bioabsorbable polymers to produce material for makingself-retaining sutures, where the native bioadsorbable polymers includepolyglycolic acid, poly-l-lactic acid, poly-d-lactic acid,polytrimethylene carbonate, PDO, PCL, protamine, polylysine and lipids.

Synthetic PHAs generally result in minimal tissue reaction whenimplanted in vascularized tissue eliciting a minimal inflammatoryresponse. However, other (bioadsorbable and non-bioadsorbable) polymerscan cause a tissue reaction when implanted into the muscle of an animal.For example, inflammation can be caused by a reaction to foreignproteins present in some natural bioabsorbable sutures. PHAs generatedfrom recombinant bacterial systems may induce an inflammatory responseand adverse tissue reaction. The tissue response would be initiatedwithin a lower limit of 1-3 hours from insertion of the suture to anupper limit of several days after insertion. The tissue response wouldendure for a period of a lower limit of 1-3 hours from the time ofinsertion of the suture to an upper limit of several days afterinsertion However, depyrogenated PHAs implanted in vivo do not result inan acute inflammatory reaction. The inflammation can amplify scarringand for this reason is not desirable. Alternatively, tissue reactionscan also induce collagen deposition at the suture site, which canimprove the holding strength of a self-retaining suture. Parallelincreases in immune activation, transforming growth factor (TGF)positive regulatory T (Treg) cells and collagen type I deposition havebeen observed consistent with early immune activation eliciting collagendeposition. Collagen deposition can also be induced through chemicalagents such as silica (see E. Cosini et al., Mechanisms of Ageing andDevelopment (2004), 125: 145-146, in ‘2002 International Conference onImmunology and Aging’, entitled “Resistance to silica-induced lungfibrosis in senescent rats: role of alveolar macrophages and tumornecrosis factor-α(TNF)”) or via stimulation of connective tissue growthfactor (see Edwin C. K. Heng et al., J Cell Biochem. (2006) 98: 409-420entitled “CCN2, Connective Tissue Growth Factor, Stimulates CollagenDeposition By Gingival Fibroblasts Via Module 3 And α-6 And β-1Integrins”). In an embodiment of this invention, the increased tissuereaction can cause an increased amount of collagen formation which canimprove the self-retaining suture tissue holding strength postoperatively. By coating the suture first polymer filament with a secondpolymer which causes a tissue specific reaction, a tissue reaction canbe induced. Further, by adjusting the thickness of the second polymercoating the time duration of the tissue reaction can be adjusted withoutsacrificing other properties of the suture such as strength. In analternative embodiment of this invention, the increased tissue reactioncan cause relatively faster collagen formation which can improve theself-retaining suture tissue holding strength post operatively.

In an embodiment of the present invention, a monofilament with apolyglycolic acid (PGA) outer layer is co-extruded with a differentbioabsorbable polymer inner layer for generating a self-retainingsuture. The purpose of the PGA outer layer is to increase a tissuereaction induced by the self-retaining suture in vivo. This increasedtissue reaction can improve the self-retaining suture holding strength(e.g., by increasing the formation of collagen tissue growth). In anembodiment of the present invention, the configurations of the innerlayer to the outer layer can be spherical-coaxial. In an embodiment ofthe present invention, the configurations of the inner layer to theouter layer can be pie shaped-coaxial. A pie shaped-coaxial filament canbe advantageous to allow the monofilament to interact with otherfilaments along the length of the non outer layer exposed surface of thefilament, while along the remaining surface of the filament where theouter layer is present tissue retainers can be inserted. In anembodiment of the invention, the outer layer can be in a preferred formfor introducing tissue retainers. In an alternative embodiment of thepresent invention, the monofilament can interact with other filamentsalong the length of the outer layer exposed surface of the filament,while along the remaining surface of the filament where the outer layeris not present tissue retainers can be inserted. In an embodiment of thepresent invention, the outer layer can be applied as a thin coating. Invarious embodiment of the present invention, the outer PGA layercomprises 50% or greater glycolide content. In an embodiment of thepresent invention, the tissue retainers are introduced into the surfaceof one or more filaments containing PGA material. In an alternativeembodiment of the present invention, the tissue retainers are introducedinto the surface of one or more filaments containing PHA material.

In an embodiment of the present invention, recombinant expressedbioabsorbable polymers can be used to make small self-retainingmonofilament filaments such monofilaments similar in size to U.S.P. 7/0,8/0, 910, 10/0 and 11/0 suture sizes. In an embodiment of the presentinvention, rPHAs can be used to make small self-retaining monofilamentfilaments such monofilaments similar in size to the U.S.P. 7/0, 8/0,910, 10/0 and 11/0 suture sizes. In a different embodiment of thepresent invention, recombinant expressed bioabsorbable polymers blendedwith non-bioabsorbable polymers can be used to make small self-retainingmonofilaments similar in size to the U.S.P. 7/0, 8/0, 910, 10/0 and 11/0suture sizes. In an alternative embodiment of the present invention,recombinant expressed bioabsorbable polymers coated with non-recombinantexpressed bioabsorbable polymers can be used to make smallself-retaining monofilaments similar in size to the U.S.P. 7/0, 8/0,910, 10/0 and 11/0 suture sizes. In another embodiment of the presentinvention, recombinant expressed bioabsorbable polymers coated withnon-bioabsorbable polymers can be used to make small self-retainingmonofilaments similar in size to the U.S.P. 7/0, 8/0, 910, 10/0 and 11/0suture sizes.

In an alternative embodiment of the present invention, bioadsorbablemonofilaments are braided together to give a bioabsorbableself-retaining suture. In an embodiment of the present invention,filament sizes can be equivalent to U.S.P. monofilament 9/0 and 10/0,but both larger and smaller filament sizes are also envisioned. In anembodiment of the present invention, more than one filament size can beused to construct the multifilament braid. In an embodiment of thepresent invention, a braided suture can be made with and without a braidcore. In an embodiment of the present invention, the braided suture corecan be a single monofilament core, a collection of parallelmulti-filaments (i.e., a core comprising many small monofilament fibershaving little or no twist), twisted multifilament core, and/or a braidedmultifilament core. In an embodiment of the present invention, bothself-retaining and non-self-retaining material can be used for thesuture core. In an embodiment of the invention, a suture made from abraid of non-self-retaining filaments and tissue retainers cansubsequently be introduced.

In an embodiment of the present invention, the self-retaining braidedsuture is braided with tissue retainers only in one direction. In analternative embodiment of the present invention, the self-retainingbraided suture is braided with tissue retainers in two directions (e.g.,in approximately opposite directions along the long length of thesuture). The sutures with tissue retainers in two directions can bemanufactured by introducing tissue retainers in the monofilaments inbidirections (i.e., with tissue retainers in both directions along thelength of the filament) or by tissue retainer insertion after themonofilaments are braided. In another embodiment of the presentinvention, a bidirectional self-retaining braided suture is constructedby braiding the suture with tissue retainers inserted into the yarns(i.e., a collection of self-retaining monofilaments) in one directionand have other self-retaining yarn fed into the braid forming point withthe tissue retainer direction in the opposite direction. For example, atypical U.S.P. size 1 braided suture is constructed with 16 sheathyarns, with each yarn being a collection of smaller monofilaments(typically referred to as a “multifilament” yarn). In this example,eight of the multifilament sheath yarns can have the tissue retainers inone direction whereas the other eight multifilament sheath yarns canhave the tissue retainers in the opposite direction. This embodimentalso includes the use of bidirection self-retaining yarns in themultifilament yarns. This embodiment also include the use of anon-systemic number of multifilament yarn in one direction verses theopposite direction. This embodiment includes the use of a standard(i.e., core with no tissue retainers) or self-retaining suture core.

In an embodiment of the present invention, a bioabsorbable multifilamentself-retaining braid is coated with a thin layer of coating materialwhich can allow the braided self-retaining suture to pass through tissueduring suturing and also allow the self-retaining suture to grip thetissue once the suture is in place. In various embodiments of thepresent invention, the self-retaining braided suture coating includesnatural wax, synthetic wax, synthetic bioabsorbable polymers (e.g., lowviscosity glycolic acid polymers, lactic acid polymers, trimethylenecarbonate polymers, paradioxanone polymers, epsilon-caprolactonepolymers, polyhydroxyalkanoates, urethane materials, and the like,including combinations of two or more of these bioabsorbable materials),natural bioadsorbable polymers such as collagen and non-bioabsorbablematerials such as silicones. Likewise, the coating material can becollagen or urethane where either material can be processed tobioabsorbable relatively rapidly or to bioabsorbable relatively slowly.In the case of gluderaldahyde treated collagen, the time taken for thecoating to be bioabsorbed can therefore be relatively long or short.

In an embodiment of the present invention, a wax coating is used wherethe melting (or softening) temperature is near body temperature (37°C.). In an embodiment of the present invention, the wax is a solid,semi-solid, or super-cooled liquid and coats the tissue retainers as thesuture is sewn into the body, but quickly softens or melts allowing thetissue retainers to immediately catch into the desired tissue securingthe suture line. In an embodiment of the present invention, the wax canbe either natural or synthetic, or a combination of the both. In anembodiment of the present invention, natural and/or synthetic additivescan be used to improve the desired properties of the wax coating.

In an embodiment of the present invention, a hybrid‘synthetic/recombinant’ monofilament suture is generated with a coaxialconstruction where the core is a non-bioabsorbable material such aspolypropylene or polybutester and with a recombinant expressedbioabsorbable PHA polymer covering the core material, and tissueretainers can be introduced into this hybrid suture. In an embodiment ofthe present invention, the hybrid coaxial ‘synthetic/recombinant’ suturecan have tissue retainers introduced unidirectionally orbidirectionally. In an alternative embodiment of the present invention,a hybrid ‘synthetic/non-recombinant’ monofilament suture is generatedwith a coaxial construction where the core is a non-bioabsorbablematerial such as polypropylene or polybutester and with anon-recombinant bioabsorbable homo or copolymer consisting of one ormore of glycolic acid polymers, l-lactic acid polymers, d-lactic acidpolymers, trimethylene carbonate polymers, para-dioxanone polymers,epsilon-caprolactone polymers, covering the core material, and tissueretainers are introduced in this hybrid suture. In an embodiment of thepresent invention, the hybrid coaxial ‘synthetic/non-recombinant’expressed suture can have tissue retainers introduced unidirectionallyor bidirectionally. In another embodiment of the present invention, ahybrid ‘natural/recombinant’ monofilament suture is generated with acoaxial construction where the core is a natural material such as silkor collagen with the bioabsorbable rPHA polymer extruded over the corematerial, and tissue retainers introduced in this hybrid suture. In anembodiment of the present invention, the hybrid coaxial‘natural/recombinant’ suture can have tissue retainers introducedunidirectionally or bidirectionally. In a further embodiment of thepresent invention, a hybrid ‘natural/synthetic’ monofilament suture isgenerated with a coaxial construction where the core is a naturalmaterial such as silk or collagen with a synthetic bioabsorbable polymerextruded over the core material, and this hybrid suture can have tissueretainers introduced. In an embodiment of the present invention, thehybrid coaxial ‘natural/synthetic’ suture can have a silk core and a PDOouter layer. In an embodiment of the present invention, the hybridcoaxial ‘natural/synthetic’ suture can have tissue retainers introducedunidirectionally or bidirectionally. In various embodiments of thepresent invention, the configurations of the core to the outer layer canbe spherical-coaxial. In alternative embodiments of the presentinvention, the configurations of the core to the outer layer can be pieshaped-coaxial.

In an embodiment of the present invention, self-retaining monofilamentyarns can be generated by using a laser as the tissue retainer cuttingdevice. Nano machining of polymers utilizes a variety of differentwavelength lasers to ablate polymers including polymethyl methacrylate(PMMA), polypropylene (PP) and polyethylene (PE) immersed in a varietyof media including air, methanol and ethanol. Selection of appropriatepulsing of the laser beam and also a polymer with an appropriate glasstransition temperature can be used to adjust the dimensions andcharacteristics of the tissue retainer formed from the polymer. In anembodiment of the invention, ultra violet and/or visible wavelengthlasers (190-800 n.m.) are used to ablate synthetic organic polymers. Inan embodiment of the invention Kr-fluoride excimer, Nd:YAG andTi:Sapphire laser can be used to ablate sutures made at least in partfrom polymers including PGA, PHA, PMMA, PPG, PS, PP and PE. In analternative embodiment of the invention, off resonance free electronscan be used to ablate polymer material from a suture either alone or incombination with different wavelength lasers to generate aself-retaining suture. In an embodiment of the invention, immersion ofthe suture in an organic solvent prior to and/or during laser ablationcan be used to control the tissue retainer size and/or depth (100nanometers-100 micrometers) that the tissue retainer is etched in thesuture. Alternatively, shorter wavelength CO₂ infra red lasers can beused to etch suture polymer material, albeit sacrificing the precisionof position and angle of the tissue retainer on the suture. (Annu. Rep.Prog. Chem., Sect. C: Phys. Chem. (2005) 101: 216-247 entitled “8Studies on laser ablation of polymers”). In an embodiment of the presentinvention, a self-retaining bioabsorbable monofilament can be generatedby using a laser as the tissue retainer cutting device. In analternative embodiment of the present invention, a self-retainingnonbioabsorbable monofilament material can be generated by using a laseras the tissue retainer cutting device. In another embodiment of thepresent invention, a self-retaining hybrid coaxial suture can begenerated by using a laser as the tissue retainer cutting device. Invarious embodiments of the present invention, the monofilament yarnshave U.S.P. suture size 7/0 and smaller. In alternative embodiments ofthe present invention, the monofilament yarns have U.S.P. size 8/0diameter and/or larger diameters.

In an embodiment of the present invention, the tissue retainer cuttingprocess is improved by cooling the suture material before the tissueretainer insertion process. The reduction in temperature will reducestatic charging of inserting tissue retainers in the material which canimprove the self-retaining suture formation/manufacturing process. In anembodiment of the present invention, the tissue retainer cutting processis improved by cooling the suture material while inserting the tissueretainers. This can be achieved by processing the suture material in areduced temperature area (i.e., via refrigeration) or by directing acooling gas or liquid onto or in the vicinity of the suture. Forexample, liquid nitrogen can be directed onto the suture. Alternatively,refrigerated air or other gases can be used to chill the suture materialprior to inserting the tissue retainers.

In an embodiment of the present invention, the monofilament is drawnwhile inserting tissue retainers to improve the tissue retainerinsertion process. Specifically, the process of ‘drawing’ a monofilamentis to apply tensile loads above the elastic deformation point of thematerial. The stretching caused by these loads yields a permanentelongation of the original filament length. The drawing results in anoptimal orientation of the molecules inside the fiber for alignment ofthe tissue retainers during the tissue retainer insertion process.

The crystal transitions of Nylon 11 annealed and drawn at differenttemperatures (T_(d)) with different drawing ratios (n) indicate that theNylon crystal transitions strongly depend on the thermal history and theconditions of drawing. The δ′form Nylon 11 can be gradually transformedinto the α-form when it is drawn at high temperature. However, theα-form was only partly transformed into the δ′-form when it was drawn atlow temperature. This is due to the effect of the competition betweenthermal inducement and drawing inducement. The thermal inducement favorsthe α-form, while the drawing inducement favors the δ′-form. In anembodiment of the present invention, different temperatures anddifferent drawing ratios can be utilized to favor formation ofappropriate crystal transitions in the suture fibers prior to the tissueretainer insertion process. In an embodiment of the present invention, amonofilament is ‘under-drawn’, i.e., generated at a reduced drawingratio but normal or elevated temperature in order to favor the thermalinducement preferred form or generated at a reduced temperature butnormal or elevated drawing ratio in order to favor the drawinginducement preferred form. Alternatively, combinations of theseprocesses can be used to further induce a preferred form or in order toreverse the preferred form before the tissue retainer insertion. In anembodiment of the present invention, the monofilament can be extruded ata reduced drawing ratio but normal temperature and then the monofilamentcan be drawn at an increased ratio during tissue retainer insertionprocess. In an alternative embodiment of the present invention, themonofilament can be extruded at a normal drawing ratio but decreasedtemperature and then the monofilament can be drawn at an increasedtemperature during tissue retainer insertion process. Additionalmonofilament draw processes and/or relaxation processes can be used tooptimize the desired properties of the self-retaining monofilamentsutures. A monofilament relaxation step is when the relative tension onthe monofilament is reduced, and this relaxation process can be carriedout at reduced temperatures, room temperature, or elevated temperatures.In an embodiment of the present invention, the relaxation step(s) can becarried out in a continuous manner (e.g., with the self-retaining suturemoving between textile godets which apply the desired tensile load). Inan embodiment of the present invention, the relaxation step(s) can bepreformed as a batch process. In an embodiment of the present invention,multiple monofilament fibers (i.e., a multifilament yarn) can havetissue retainers introduced at the same time in a similar manner as theabove monofilament self-retaining-drawing embodiments. In theseembodiments, the temperature or drawing ratio may be adjusted to resultin a preferred form of one or more of the constituents of themultifilament yam. For example, in a coaxial suture, the preferred formfrom a strength perspective of the inner fiber may be generated duringextrusion, while the preferred form of the outer layer from a tissueretainer insertion perspective may be generated prior to tissue retainerinsertion.

In an embodiment of the present invention, the suture comprises polymermaterials which exhibit complex elastic-plastic deformation profiles.Polybutesters have different block crystalline zones which cold-work atdifferent tensile loads and therefore yield an elastic-plasticdeformation profile which can be approximated by two differentelastic-plastic deformation profiles superimposed but offset from eachother. In an embodiment of the present invention, the suture comprisespolybutester filaments. In an embodiment of the present invention,polymer materials which exhibit complex elastic-plastic deformationprofiles allow for tissue retainer insertion of materials which exhibithigh strength plastic deformation while retaining a relatively goodelastic profile well above a typical polymer plastic deformation point.These properties can be especially useful for self-retaining insertionsuture materials used for cardiac self-retaining sutures.

In an embodiment of the present invention, a testing procedure todetermine the strength of a self-retaining suture uses a pottingmaterial to retain one end of a self-retaining suture to yield aconsistent test. In an embodiment of the present invention, aself-retaining suture can be inserted in a vertical cylinder and thecylinder can be partially filled with a liquid or gel which cures into asolid, then the potted end of the self-retaining suture can be securedand the free end of the self-retaining suture can be tensile pulledusing a standard tensile testing machine. In an embodiment of thepresent invention, a self-retaining suture can be inserted in a verticalcylinder and the cylinder can be partially filled with a siliconepotting compound (for example, room temperature curing silicone) fortensile testing. In various alternative embodiments of the presentinvention, a hydrogel can be used as the potting compound. In anembodiment of the present invention, CoSeal™ can be used as the pottingcompound to secure the self-retaining suture to yield a consistent test.In an alternative embodiment of the present invention, ConfluentSurgical DuraSeal™ can be used as the potting compound. In an embodimentof the present invention, a self-retaining suture can be inserted in avertical cylinder and the cylinder can be partially filled with collagenfor tensile testing. In various embodiments of the present invention,the collagen can be non-solvated or solvated. In another embodiment ofthe present invention, animal fat (such as pig fat or cattle fat) can beused as the potting material for the self-retaining suture test. In analternative embodiment of the present invention, synthetic wax can beused as the potting compound. In various embodiment of the presentinvention, the potting compound can be non-crosslinked, semi-crosslinkedor crosslinked to improve the holding strength of the potting compoundwith respect to the self-retaining suture. In alternative embodiments ofthe present invention, the temperature of the potting compound can beadjusted to improve the holding strength of the potting compound withrespect to the self-retaining suture. In various embodiment of thepresent invention, other potting materials can be selected from the setconsisting of “foam-in-place” materials, ultra violet light cross linksensitive polymers, clays, rubber, packed powder and cement.

In an embodiment of the present invention, self-retaining sutures can begenerated from twisted collagen filaments which have been chemicallycrosslinked to improve the catgut suture strength and increase thebioabsorption time. In an embodiment of the present invention,self-retaining sutures can be generated from catgut sutures which havebeen treated with gluderaldahyde. Catgut sutures are traditionallow-strength and relatively fast absorbing sutures made from twistedcollagen. Because of the twisted ribbon-like nature of catgut suture(such as plain and chromic acid treated catgut sutures), these filamentsare generally not suitable as self-retaining sutures. However, bytreating the collagen with cross linking reagents such asgluderaldahyde, an extremely durable and long lasting collagen suturecan be made with monofilament-like properties. Common catgut suturemanufacturing methods including treating with hydrogen peroxide,bleaching agents, chromic acid, oxidizing reagents, acids, twisting,drying, and center less grinding can be performed prior to crosslinking.In an embodiment of the present invention, the chemical crosslinking canbe carried out before the tissue retainers are cut into the collagensuture. In an embodiment of the present invention, the chemicalcrosslinking can be carried out after the tissue retainers are cut intothe collagen suture. A gluderaldahyde treaded catgut suture can havetissue retainers introduced into a low cost self-retaining suture whichcan be manufactured to be essentially non-bioabsorbable. Any source ofcollagen can be used to make collagen fibers which in turn can be usedto make collagen sutures.

In an alternative embodiment of the present invention, prior to tissueretainer insertion a collagen suture is coated with a compoundcomprising one or more of an absorbable collagen coating, anon-absorbable collagen coating, an absorbable urethane coating, asynthetic bioabsorbable polymer coating, a non-absorbable polymercoating.

Approximately with respect to temperature means ±10% of the statedtemperature, i.e., approximately 50° C. includes the range 45-55° C.Approximately with respect to extension to break strength means ±10%,i.e., approximately 40% extension to break strength includes the range38%-46% extension to break strength.

Example embodiments of the methods, systems, and components of thepresent invention have been described herein. As noted elsewhere, theseexample embodiments have been described for illustrative purposes only,and are not limiting. Other embodiments are possible and are covered bythe invention. Such embodiments will be apparent to persons skilled inthe relevant art(s) based on the teachings contained herein.

Thus, the breadth and scope of the present invention should not belimited by any of the above-described exemplary embodiments, but shouldbe defined only in accordance with the following claims and theirequivalents.

1. A suture comprising: at least one filament; a coating including atleast one coating material, wherein the coating is applied to one ormore filament, wherein the coating assists the suture passing throughthe tissue during suturing.
 2. The suture of claim 1, wherein the atleast one coating material is selected from the group consisting ofnatural wax, synthetic wax, low viscosity glycolic acid polymers, lacticacid polymers, trimethylene carbonate polymers, paradioxanone polymers,epsilon-caprolactone polymers, polyhydroxyalkanoates, urethane,collagen, silicones and polyhydroxyalkanate polymers.
 3. The suture ofclaim 1, wherein the at least one coating material is selected based onthe at least one coating material melting point temperature, wherein thecoating is solid during suturing, wherein the coating melts as thesuture is heated to the temperature of the tissue, wherein after thecoating melts the suture is retained in the tissue.
 4. The suture ofclaim 1, further comprising at least one tissue retainer, wherein thetissue retainer is introduced into the surface of at least one of the atleast one filament to retain the suture in tissue, wherein the coatingassists the suture passing through the tissue during suturing.
 5. Thesuture of claim 4, wherein at least one of the at least one tissueretainer is a barb.
 6. The suture of claim 4, further comprising aplurality of tissue retainers, wherein the tissue retainers introducedinto the surface of at least one of the at least one filament arebidirectional.
 7. The suture of claim 1, further comprising at least asecond filament and wherein at least two of the at least two filamentsare braided together.
 8. The suture of claim 1, wherein at least one ofthe filaments includes material selected from the group consisting ofsilk, collagen, polypropylene and polybutylester.
 9. A self retainingsuture comprising at least one filament including: at least onenon-bioadsorbable component; a bioadsorbable polymer coating, whereinthe bioadsorbable polymer coating is applied to at least one of the atleast one non-bioadsorbable component; and at least one tissue retainer,wherein the tissue retainer is introduced into at least one of the atleast one filament to improve retention of the suture in tissue.
 10. Thesuture of claim 9, wherein at least one of the at least one tissueretainer is a barb.
 11. The self retaining suture of claim 9, whereinthe non-bioadsorbable component is selected from the group consisting ofcollagen, polypropylene, polyester, nylon, polyamide, polybutesters,polyetherester, polyetheretherketone, polyethylene, polyethyleneterephthalate, polyurethane, polypropylene, polytetrafluoroethylene,metals, metal alloys, cotton and silk.
 12. The self retaining suture ofclaim 9, wherein the coating is selected from the group consisting ofpolyhydroxyalkonate, polyglycolic acid, poly-l-lactic acid,poly-d-lactic acid, polytrimethylene carbonate, polydioxanone,polycaprolactone and biodegradable collagen.
 13. The self retainingsuture of claim 9, wherein the coating stimulates a tissue responsereaction after the suture is implanted in vivo.
 14. The self retainingsuture of claim 13, wherein the tissue response reaction increasescollagen deposition in a region around at least one tissue retainerinsertion site to improve retention of the suture in tissue.
 15. A selfretaining suture comprising at least one bioadsorbable polymer filamentincluding: a coating; and at least one tissue retainer, where the tissueretainer is introduced into at least one filament to improve retentionof the suture in tissue.
 16. The self retaining suture of claim 15,wherein at least one of the bioadsorbable polymer filament isrecombinant polyhydroxyalkonate (rPHA) polymer.
 17. The self retainingsuture of claim 16, wherein the coating is crosslinked to the rPHAmaterial.
 18. The self retaining suture of claim 15, wherein the coatingis selected from the group consisting of polyglycolic acid,poly-l-lactic acid, poly-d-lactic acid, polytrimethylene carbonate,polydioxanone, polycaprolactone, polyurethane, protamine, polylysine andlipids.
 19. The self retaining suture of claim 15, wherein the coatingstimulates a tissue response reaction after the suture is implanted invivo.
 20. The self retaining suture of claim 19, wherein the tissueresponse reaction increases collagen deposition around at least onetissue retainer insertion site to improve retention of the suture intissue.